This review article discusses prenatal screening and diagnosis of neural tube defects (NTD). High detection rates occur in countries operating ultrasound screening programmes because classical two-dimensional ultrasound cranial signs (lemon shaped head, banana cerebellum, ventriculomegaly) are important diagnostic clues to the presence of spina bifida. Careful evaluation of both the spine and a search for other abnormalities is warranted. Important prognostic information for spina bifida relates to the lesion level, with a "watershed" between L3 and L4 marking a very high chance of being wheelchair bound with the higher lesions. Three-dimensional ultrasound using multiplanar views can achieve diagnostic accuracy within one vertebral body in around 80% of patients. There are high rates of pregnancy termination for spina bifida in many European countries, but the use of new imagining techniques allow better prediction of outcome, and consequently a refinement of prenatal counselling.
The use of seclusion within a psychiatric intensive care unit in a South Australian metropolitan mental hospital was documented over a ten week period. The seclusion rate within the unit was 32% of all admissions and 34% of new admissions. The overall seclusion rate for the hospital was 5.4% of all admissions and 6.3% of new admissions, somewhat higher than in the United Kingdom but considerably lower than in the Eastern United States. A comparison was then made between consecutive new admissions (30 secluded and 30 non-secluded) to this unit and to a similar unit without a seclusion room in the other mental hospital in the State. Although seclusion offered no clear advantages in terms of duration of admission, levels of medication or relapse rates, it appeared to reduce the level of dangerousness in the unit, thereby enhancing staff morale. The overall mean daily total of neuroleptic medication was about 1,200 mg chlorpromazine equivalent, somewhat less than in comparable units in the United States and Europe.
THE knowledge that permanent renal damage may follow infections of the lower urinary tract has led to various postoperative prophylactic measures. These include avoidance, whenever possible, of the use of catheters. However, vaginal repair operations are so often followed by retention of urine that it is generally necessary to drain the bladder by means of an indwelling catheter. This could be discarded only if the bladder were induced to empty itself normally.For this purpose a number of drugs have been used. They fall into two main groups: synthetic choline esters and anticholinesterases. Of the former carbamyl-choline (carbachol) and carbamyl-beta-methylcholine (bethanechol) have been used clinically. The action of both is shortlived and they possess unwanted side effects. Although Garvey et al. (1949) found bethanechol relieved urinary retention in 60 per cent of postoperative patients, a controlled study by Fleming (1957) showed that its use did not diminish the need for catheterization, or the volume of residual urine in the puerperium.A new anticholinesterase, distigmine bromide (Ubretid) which closely resembles neostigmine was reported by Mermon (1962aMermon ( , 1962b and Partilla and Deimer (1964) in the treatment of intestinal and bladder atony. In a clinical trial, supported by tonometry studies, they found that U bretid possesses a prolonged effect on bladder contractility. Ubretid, hexamethylene bis (Nmethylcarbaminoyl-3 hydroxy-l-methylpyridinium-bromide) acts by potentiating the effect of acetyl choline.The purpose of this study has been to determine by means of a preliminary double-blind trial whether Ubretid assists normal bladder emptying after vaginal repair operations. MATERIAL AND METHODFifty-four patients who had vaginal repair operations were included in the series. No vaginal pack or catheter was inserted postoperatively.Ubretid 0.5 mg. was supplied in 1 ml. ampoules, with identical ampoules containing 1 ml. of physiological saline as controls. The ampoules, labelled with the code number, were randomized and dispensed in numerical order.The patient was given one intramuscular injection 12 hours after her return to the ward. A specimen of urine was examined bacteriologically preoperatively and ten days after operation. RESULTSTwenty-four patients received the active drug and 30 the placebo. Of the former, 12 passed urine spontaneously and required no catheter at any stage. Of the 30 who received the placebo, catheterization was required in 21 and, although 9 patients were able to pass urine, 3 required repeated catheterization for large volumes of residual urine. 80 per cent of the control patients, therefore, required catheterization, compared with 50 per cent of those treated with the active drug.No side effects of the drug were noted. The type of operation performed was not related to the patients' ability to pass urine (Table I).Significant bacteriuria (> lo5 organisms/ml.) was found more often in patients who had been catheterized than in those who had not. Of 33 patients who had been...
We investigated the accuracy of using symphysis pubis-fundal height measurement and ultrasonically derived estimation of fetal weight for identifying small-for-gestational-age (SGA) and large-for-gestational-age (LGA) fetuses. A retrospective cohort study was performed using computerised records of all non-diabetic women referred for an ultrasound growth scan (US) with clinically suspected SGA or LGA singleton fetuses from 35 weeks' gestation between October 2008 and March 2009 (n = 185). Birth weight data were also collected for all births over the study period (n = 3200). One-third (34%) of ultrasound estimated fetal weights were inaccurate by >10%. However, an inaccurate ultrasound estimation did not significantly increase the likelihood of spontaneous or induced onset of labour or delivery by caesarean section. Most (79%) growth scans were performed on well-grown fetuses. The majority (80%) of SGA and LGA babies in our cohort were not identified by clinicians during routine antenatal care. From 3,200 live births, there were a total of 59 infants weighing <2,500 g or >5,000 g. Of these, only 12 had been referred for an ultrasound growth scan, indicating that abdominal palpation and fundal height measurement has a 20% sensitivity in detecting SGA or LGA fetuses. Of the 12, four were detected using ultrasound, indicating a 33% detection rate. Although ultrasound has a slightly higher sensitivity, neither clinical examination using fundal height measurements nor 3rd trimester ultrasound examinations are effective at detecting SGA or LGA fetuses.
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